Provider Demographics
NPI:1225395809
Name:CARDINALE, LISA (RN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:CARDINALE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:230 W WILLOW ST
Mailing Address - Street 2:406
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-1026
Mailing Address - Country:US
Mailing Address - Phone:315-744-3763
Mailing Address - Fax:
Practice Address - Street 1:230 W WILLOW ST
Practice Address - Street 2:406
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-1026
Practice Address - Country:US
Practice Address - Phone:315-744-3763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-19
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY605783-1163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical